After improvement from stroke, conditions deteriorated due to contrast medium application during physical check-up
There was an old man who suddenly became unable to stand steadily while giving a speech. Since then, he had problems even bending over to pick things up. He had to use a walking frame to help him walk and later he had to switch to a crutch for support. When he first visited me, he said his limbs trembled and he would feel like falling without the support of a frame. The conditions were getting worse.
The 66-year-old patient lived in Macau. His complexion was dull and dark with dark purple-brown lips. He swayed from side to side and walked unsteadily. Also suffered from high blood pressure, he had been taking antihypertensive drugs for three to four years, but his diastolic blood pressure was still very high. There had been no nocturnal penile tumescence for several years due to weaknesses in his liver and kidneys. His feet started to swell a year ago and this became more pronounced after half a year, indicating weaknesses in his heart and kidneys. He couldn’t speak or pronounce clearly, for example the “Ta” sound was not audible. He failed to pronounce clearly the names of his grandchildren or some other things. When he wrote, he couldn’t control his hands, so the writings were large and he couldn’t write them smaller.
He said that since the onset of the problems, he had seen a number of Chinese and Western doctors, all failing to find out the causes. Some Western doctors said he had Spinocerebellar Ataxia. His MRI images indeed showed dryness and atrophy in his cerebrum, but the cerebellum was not clearly shown. Because of his speech problem, I initial thought was that he suffered from a sudden and mild stroke during the time he was giving a speech, which affected his ability to speak. The stasis in his brain caused by the mild stroke blocked the cranial nervous system and hindered the transmission of signals to the cerebellum for order giving, making it difficult for him to walk.
Deep sleeping and reduced feet swelling
After taking the medicine, he always wanted to sleep. He once fell into a slumber, sleeping until dawn without waking up for urination at night. Compared with waking up three times a night to urinate before, his condition had become much better, showing immediately improvement in kidney functions. His body sweated every night, but not too much. In the second follow-up consultation, his feet swelling had obviously reduced. When pressing the feet, the dimple rebounded and the skin appeared wrinkled, though the colour was still dull red and black, indicating his heart and kidneys were being strengthened. The darkness of his complexion, compared with the previous time, had completely disappeared. The skin had become fair, pinkish and much brighter. His wife and son agreed that his complexion had greatly improved. His speaking was still clumsy and his walking was similar to the previous time with no improvement. Some urine samples he brought were light yellow with white cholesterol precipitates, while others were light orange and orange, indicating heart problems with necrotic cells being brought out from the myocardium.
Later, the patient called and said that he had not slept well. He woke up after only three or four hours of sleep at night. After that, he could not fall asleep until dawn. His wife suspected that the time of taking medicine might matter and asked if the time can be delayed so that he could sleep well at night. I told her he could try. During the third follow-up visit, the wife said that changing the medicine taking time had worse effect. Patient could not fall asleep at night and could only sleep for one or two hours in the afternoon, so he felt tired and could not walk steadily. The wife said that before the insomnia problem, there was apparent improvement. He could walk briskly and lift his heels. Every time he finished drinking the medicine, he felt a hot current rising from his feet. I asked if it went straight to the head. He said no at first, but later corrected that he felt his head bloated. The frequent inconsistency in describing his conditions indicated confusion in his thinking.
Besides, he was able to move his tongue more flexibly and his speaking had become increasingly clear compared with that when he first visited me. He could say his name and his four grandchildren’s names very clearly. His urine showed no brown or dark colours at all. There could be two possibilities. First, his heart was still not strong enough, causing insufficient blood supply for the brain, so the deep stasis could not be brought out. Second, he did not have a mild stroke but Spinocerebellar Ataxia which caused impaired order giving. To return to normal, the treatment would take a long time.
Although the treatment had only been two weeks, I felt that the patient lack confidence in me, so I said to the patient seriously: “your neurological illness will take more than one year to be cured, but within these two weeks, your swollen feet have been cured and your walking and complexion have improved. Who else can achieve these so quickly?” After hearing this, he was speechless.
Improved walking without crutches
Based on my analysis, patient’s insomnia issue was mainly due to the lack of blood supply to the brain. As such, I focused on removing blood stasis and strengthening his heart. The patient’s wife called and said that it was very effective and her husband was able to sleep peacefully. In the fourth follow-up consultation, the patient felt energetic. His complexion was pinkish with lust, and he frequently showed a smile on his face. He could walk very steadily without wobbling. In addition, he wished to meet one of my female patients, who also had similar symptoms, hoping to exchange each other’s experiences. This female patient suffered from Brain Atrophy. When she first arrived, she was short of breath, unable to maintain her balance, bumped and fell easily, and had to be supported by her husband while walking. Her heart was very weak. She told my new patient saying, “this disease is very difficult to be cured. The most important thing is to have confidence and follow the doctor’s instructions. During the period, ups and downs of medicine effects are inevitable, but don’t be discouraged.” She also demonstrated walking and going up the stairs to prove the effects of my treatment for her. Her husband could also tell my new patient’s lack of confidence in me, so he said to him, “given that we have met Dr. Au, we should cherish this opportunity and get treated.” The patient appeared submissive after listening and seemed to accept their advice. I asked patient if he had nocturnal penile tumescence in the past three weeks. He smiled and said yes, adding that it had not happened in several years. In addition, the patient had large amount of urination in the morning with strong discharge, indicating that the kidneys had regained qi and its functions were getting better and better.
After four months of treatment, the patient could walk without a crutch or support from others. At first, it was a little unsteady when he started to walk, but after some time, it became very smooth and he could even lift his feet and walk a few laps. When waiting at the clinic, he walked to get water by himself for several times and there was no problem at all. When I asked him about the progress of his condition, he always replied “about the same”. His wife and I called him “Mr. about the same.” At the sixth follow-up visit, he told his accompanying friends that he walked better. Normally, he would say “about the same,” he must have felt much better to say that.
Condition deteriorated with contrast medium application
In the eighth follow-up consultation, patient said he was very tired lately, always wanted to sleep and his limbs felt weak. I explained this was a sign that the medicine was opening up his heart blockage. His hands and feet were very warm. He still sweated when he slept at night, but not as much as when he first visited. His pulse was even and strong. He had normal defecation every day. He often had nocturnal penile tumescence in the morning. His wife said that he walked better and better, briskly and powerfully, unlike in the past when he could not lift his feet and dragged while walking. This was because the cranial nerves were nourished and activated by the blood. Magnitude of signals had become stronger for it to be transmitted to the feet, so his walking had returned to normal.
At the tenth follow-up consultation, there was a slight dent on his leg when pressed but didn’t look like edema. Patient felt that the progress was too slow and hoped to walk like a normal person as soon as possible. However, I thought that for patients like him, there was no other way but to first strengthen the heart, liver and kidneys as well as improve the cranial nerve system. After receiving treatment, some people recovered faster and some slower. Based on my observation of this patient, his walking was about the same as before, without significant improvement or regression. During the following two weeks, the patient’s walking conditions had suddenly changed, sometimes good and sometimes bad. Sometimes he felt weakness in his feet. At the 14th follow-up visit, the patient was again a little unsteady when walking and swayed from side to side. I reassured him that this was a phenomenon that would inevitably occur during the treatment process and there was no need to worry too much. The accompanying friend said when he played mah-jong with him, his moves were quick, his mind was agile and his mental state had greatly improved. Even so, the patient was still wrapped up in his walking problem, so I spent another half an hour to explain to him again.
Based on my observation, patient’s mind had become very clear. He fully understood what he heard when talking with the others and sometimes he could answer with witty words. His mind was agile and his hand movements were fully controllable. By the 17th follow-up visit, the patient could walk even more steadily and swayed less than before. His wife said that in the past, when he was sleeping, he would punch violently like he was hitting someone in his sleepwalk, but now he had calmed down a lot. Some urine samples he brought had turned dark reddish brown, indicating that the stasis in his heart and brain were being brought out. In the previous few weeks, the patient thought that his walking had not improved much, but his wife said that there was little improvement, he was able to lift his feet slightly higher.
After the 27th follow-up consultation, patient called and said that his feet trembled. I thought this was a very good sign, indicating the activation of the neural system. Even my Parkinson or Brain Atrophy patients had experienced this. This patient did not experience this until now was a result of the accumulation of medication effects. However, the patient insisted that there was no progress. It was still sometimes a little unsteady when he walked. His temper had deteriorated and he often quarrelled with his wife.
The patient’s son and daughter recently brought me their father’s MRI brain images taken in 2004 and February this year for comparison. Not until then that I knew the patient had a brain MRI scan recently with the application of radioactive contrast medium. Contrast medium causes serious damages to patients with Brain Atrophy. Later, when I compared the two images, I found that he did suffer from Brain Atrophy. I suddenly understood why his conditions had suddenly deteriorated recently. For example, he did not speak as clearly as before. He accidentally swallowed food into the trachea. He swayed when walking. These were all related to the application of contrast medium. I told the patient that he was suffering from an incurable disease. If it worsened, it could cause severe dementia. I hoped that he would continue the treatment to maintain the conditions or, even better, to have slight progresses. The patient later discontinued with the treatment and nothing I could do. If he had continued with the treatment, I was confident that his conditions would have remained stable without deterioration or even seen improvement again. There were 8 months between 5th October, 2006 when the patient was first diagnosed and 8th June, 2007. He was treated for 35 times during the period.
This article was written by Dr. Sik-Kee Au
April 11, 2017
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Medical case number: 061005